Tolga Aksu, MD
@MDTolgaAksu
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Rhythm Specialist, FEHRA, AE in JECG, SoMe and AE in @JICE_EP , dady of a princess, Prof in @YeditepeUni ANS, VVS, brady ablator Opinions are my own🎾🏇🏍🏂🎸
İstanbul, Türkiye
Joined August 2017
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What a great honor for us to see this tweet
CNA may be associated with substantial reduction in recurrence of AVB episodes, obviating the need for a pacemaker in well selected patients with FAVB
@MDTolgaAksu
#AHAJournals
#Epeeps
0
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This is the happiest moment of my academic career. To publish an original article in
@CirculationEP
has been my dream since I started my EP career. Now, we will publish CNA in AVB. Indications, procedural steps, and results. Thanks to all co-authors.
@drrakeshg1
@DhirajGuptaBHRS
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7
244
Finally. Our paper is online in CircEP . CNA for Treatment of AVB co-authors
@drrakeshg1
@DrSerdarBOZYEL
@YalinKivanc
and
@DhirajGuptaBHRS
4 suppl videos 2 suppl figures and many more
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Dear Colleagues
As you know that Türkiye has recently been struck by devastating earthquakes. 10 cities have been severely affected. In this difficult time, to ask for your support, we organize an online EP meeting to discuss novel and advanced EP techniques with leading experts
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After a very busy EP Lab day, now the time is to celebrate my birthday with my princess.
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Really emotional moments for me. In 2011, we started EP program in Kocaeli. A lot of great colleagues joined to our team. Today was my last day in here. Now, I will have a new journey in
@YeditepeUni
in Istanbul.
@DrYerebakan
Thanks to all friends.
@tumerdemguler
@DrSerdarBOZYEL
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3
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This is the one the most important moments of my academical life. I would like to thank to scientific committee of
@HRSonline
for their kind invitation. I will try to discuss why
#dontpaceforVVS
(it is usual 😀) but in
#HRS2020
(😱)
@AndreaRussoEP
@deering_f
25
12
131
We were waiting for this for a long time. Now the time to discuss expanding horizons in CNA.Potential therapeutic effects of EGM-guided CNA in LQTS was accepted in
@JICE_EP
Initial results were presented in
@HRSonline
2020 online material(2).
@drrakeshg1
@kyalin4
@DrSerdarBOZYEL
14
30
103
I am so glad for that this is my first accepted paper in
@CirculationEP
I know it is just a letter but well begun is half done ☺️ 4 of 5 references consist of our works (3 of 4 in
@JICE_EP
and 1 in
@pace_journal
)
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Please look at that. It is a great honor for me to see my friends in Istanbul
@JRWinterfield
@drrakeshg1
@hhuang123
@TinaBaykaner
@psharmadoc
and thanks to
@AbbottCardio
to make it happen
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8
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I am so glad that our article was accepted in
#europace
It will be the second largest series about CNA in VVS. And we will have a chance to officially discuss usage of HUT in not only during diagnosis but also in FU of patients after CNA.
@kyalin4
@drrakeshg1
@DrSerdarBOZYEL
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9
102
I was so glad to have been invited as a faculty to
@HRSonline
Scientific Meeting to speak on CNA! My recorded lectures are now available online as part of the CME course "Neuromodulation of the heart: Syncope to Ablation." I hope I have a chance to join personally in future
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1
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I feel deeply honored to be invited to
@JElectrocardiol
as an Associate Editor of the Section ECG & ANS, along with Prof R Varriele. I would like to thank to
@adribaran
for his kind invitation. I will try to do my best for this great journal. Let’s send your ANS papers.
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2 mentors
@Davilandre
@CarlChiefCard
1 unbiased
#EPeeps
@DhirajGuptaBHRS
and 1 CNA guy (myself😊) “CNA for VVS and AVB: A Step-by-Step Guide” just released in
@JCardioEP
How we approach our cases? Thanks to
@DrBradleyKnight
for kind invitation
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Anatomy and Physiology of Intrinsic Cardiac ANS: Da Vinci Anatomy Card
#2
is now available online in
#JACCCaseReports
@JACCJournals
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The hearts of humans contain more than 1500 autonomic ganglia (AG). Grouping AG in different sites of atria are called as GPs. Despite epicardial localization of AG, there is a highly dense network of sensory and efferent nerve fibers in myocardial and endocardial levels
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Arrhythmic MVP expert consensus document
#EHRA2022
check, ECG (T wave inv) Holter or longer ECG recording (PVC/NSVT), if there is high risk consider ICD or ablation.
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Dear colleagues Finally the first multicenter work in CNA has been accepted for publication in
@JCardioEP
I would like to thank to all co-author to be a piece of my dream.
@Davilandre
@tomdepotter
@DhirajGuptaBHRS
@drrakeshg1
@Zo_EP2
@drdavidsingh
@srissundaram
@DanielAlyeshmer
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I am a big fan of physiological pacing via HBP-LBBP. But, our CNA method seems as the most physiological one. Am I wrong? 🤣🤣🤣 We performed just a quick map and ablation because he was the last case after a very long day. So, please forgive me for mapping quality.
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How to perform CNA for VVS and functional bradycardia
Our latest article with Prof Sunny Po is now online available in
@hrs_journal
⬇️⬇️⬇️
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A quick demonstration of a CNA case,step by step Fig1 demonstrates where we did ablation according to our EAM-guided ablation and names of GPs on those sites.The patient was 46 YO F.She had 16 VVS epiodes and 22s asystole on HUTT So, we checked scar distribution around SN and AVN
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Dear all.We were working for that for more than 1.5 years. Let me introduce the issue of
@JAFIB_
that focuses on the ANS from anatomy and physiology to sophisticated interventional therapies. It was a huge honor to share guest editorial w B Olshansky
11
21
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Patient Selection for CNA Based on Supporting Evidence. Our new paper will be available soon. Pathopyhsiology of vagally mediated bradyarrhytmias, use of HUT and ILR, and relevant literature for CNA. We will have also some great news about ANS and Heart. This is just a spoiler.
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This is a great proud that we recently published the second largest series (51) about CNA in VVS
#Europace
@ESC_Journals
We demonstrated that HUT may be a valuable diagnostic tool not only to select suitable candidates but also to evaluate success of CNA
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I strongly invite all
#EPeeps
who want to learn different views about CNA. Of course, it will be a great honor for me to be together with the masters of CNA, again. Let’s join us.
@shivkumarmd
@LuigiDiBiaseMD
@DrJasonAndrade
@jacabreracardio
@DrBradleyKnight
@StavrosStavrak1
We have great news,
#Cardioneuroablation
thru clinical cases, join us and this excellent team at Aug 22nd
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Dear All
We are very pleased to thank you for your participation.
We greatly appreciate you for taking the time and effort to contribute and sharing ideas and expertise, which contributed to make our
@2023WSA
a very successful and exciting event.
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11
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Dear colleagues
I feel deeply honored that CNA will be discussed in the highest level. Our article was accepted for publication in
#EHJ
.
@ESC_Journals
I would like to thank to co-authors
@CarlChiefCard
R Sutton and contributors
@ArturFedorowski
and Prof Deharo
@ehj_ed
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I was checking some books from my earlier carrier. The holy books of EP and device. I can’t remember how many times I read them. ✊
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Dear
#EPeeps
#HRS2022
” ended with a great success. It was certainly the best meeting of the year.
@HRSonline
Congratulations all the team and pacesetters working hard for 3 days. I hope to see you all in the next year in New Orleans
#HRS2023
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So glad this manuscript will be our first article in
@JACCJournals
family.
#JACCCaseReports
A challenging ECG, differential diagnosis of vagal AVB, procedural steps of CNA, and an unusual vagal modulation response. Co-authors
@drerkanbaysal
@drrakeshg1
@kyalin4
@DrSerdarBOZYEL
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11
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My first persistent AVB cases w
#Carto
.
@BiosenseWebster
27YOM was referred due to persistent 2 degree AVB in daytime and high-degree AVB during evening time(Fig1). No 1:1 AV conduction. Vagal AF was also detected in one of his Holters. Complete resolution after atropine (Fig2)
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With our traditional instrument “bağlama”. I learned to play it by my father when I was 6 YO. He is always better than me although he hasn’t played it for a long time.
@adribaran
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2
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Dear all
The first CNA case in a pregnant woman w malign VVS is now online in
@JACCJournals
2 pregnancies ended with spontaneous abortions due to fetal bradycardia at 26 and 30 years of age. During the current presentation, the patient was 34 YOA, at a gestation period of 9 weeks
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A simple methods for TSP in a case with challenging IAS. IAS was elastic. the needle couldn’t be advanced. Deep inspiration maneuver worked again on the basis of basic physiological principles.
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Dear
#EPeeps
Great honor for me to share practical decision pathway for the management of VVS.
Summary of studies evaluating the utility of interventional treatments in VVS
When PM? When CNA?
Online available in
#EHJ
@escardio
@ESC_Journals
@ehj_ed
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A birthday cake from your little girl should be the best gift to receive on these worst days. 🎂
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Step by step CNA. Try to demonstrate the relationship between SVC-RSPV, CS os and lower septal RA, LAA and LSPV, and IAS by biatrial mapping. It will give you a chance to ablate great majority of GPs even with empirical anatomic approach
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Finally, this will be my first paper in
#JACCCEP
@JACCJournals
CNA in a pregnant women with malignant VVS. Thanks for my co-authors
@Davilandre
@hhuang123
now we completed the task. there is at least one CNA paper in all arrhythmia journals 😊
@shivkumarmd
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Finally, our
@JICE_EP
team is together in the dinner
#HRS2022
thanks to make it happen.
@hhuang123
@psharmadoc
@DhirajGuptaBHRS
@Dominik_Linz
@Jackson_J_Liang
@MaggieInfeld
The chair of
@WArrhythmia
Prof Ali Oto joined us in the dinner.
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I have so excited times not only for me but also for whole CNA guys. CNA has been officially discussed in a special session in
#ESCCongress
@escardio
with the legends of the field. Medications by
@ArturFedorowski
Pacing by Brignole, Discussion by Deharo and chairing by Sutton
4
12
69
Our new paper was accepted in
@JCardioEP
PVI is often associated with neuromodulation effects, both intraprocedurally with VR as well as on FU with increase of HR. Why these autonomic effects are not universal? Coauthors
@drrakeshg1
@DhirajGuptaBHRS
@YalinKivanc
@DrSerdarBOZYEL
10
6
68
Great news in the last day of
#EHRA2021
I was invited to
#HRS2021
to present step-by-step CNA in VVS from diagnosis to treatment. I hope to discuss all procedural steps within 8 minutes. Thanks to scientific committee of
@HRSonline
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3
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It's been 1 week since I left my lovely baby and my wife because of covid. She is a Paw Patrol fan. She is singing the theme song for his father. 😭 ❤️ I hope we will defeat this tragedy, soon🙏
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2
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It is a great pleasure to see such a high attention to CNA. Please look at the room on my view. Now, we should work hardest for missing pieces of the puzzle
#HRS2023
@HRSonline
Honored to share the stage with pioneers, innovators, creators and disrupters.
#CNA
is an opportunity for improving young patients with functional Brady, and can improve outcomes of AF ablation
#HRS2023
@JRWinterfield
@DrRoderickTung
@MDTolgaAksu
@jczerpa
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14
70
1
9
67
"2021 update for permanent pacing in VVS" published in
@JElectrocardiol
You can read our perspective (
@satish_r_raj
@drjohnm
) based on clinical evidence.
@adribaran
@gokselcinier
@drrakeshg1
@drraviele
@narrowQRS
@SergioPinski
@rdschaller
2
17
66
Intrinsic Cardiac Neuromodulation in Management of AF- A Potential Missing Link?
*The schematic view of GPs
*EGM types for GP mapping
*Adv and disadv of GP mapping techniques
* Summary of RCTs
@DhirajGuptaBHRS
3
18
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Why fragmented EGMs are better than empirical anatomical ablation to define GPs? We perform empirical ablation in RSGP anatomical site btw 35-50th seconds of video. No HR increase. Then, we find fragmented EGMs (52th seconds) and HR increases in the first RF point.
5
12
64
A simplified flowchart for initial diagnosis of syncope.
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In this young case with VVS, CARTO mapping and Prucka EP recording systems were used to detect GPs. In Prucka, you can select 100-500Hz to detect fragmented EGMs. EPWorkMate recording system of
@AbbottCardio
with 200-500 Hz is better for EGM detection but Prucka also works.
4
9
64
One of the most comprehensive reviews about CNA. The future of CNA in cardiovascular medicine
With my dear friend
@hhuang123
and his brilliant fellow
@YeditepeUni
0
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It is obvious that entrainment maneuvers are very important to understand mechanism of reentrant arrhythmias. However, HD catheters made mapping and ablation easy. No doubt.
#HDgrid
#ablatethegap
Propagation map w 0.2mV
2
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61
Management of total PV occlusion occurring 3 months after AF ablation.
@hhuang123
@DrJasonAndrade
@Dominik_Linz
@Dr_Santangeli
@aalahmadmd
@natale_md
@LuigiDiBiaseMD
@DrRoderickTung
@chris_sohns
@tomdepotter
@drluissaenz
@Davilandre
@DrFerminGarcia
@Dr_Markman
@drrakeshg1
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14
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PreCNA sinus rate and AVB are seen in fig1. Fig2-3 demonstrates ablation points. Final sinus rate and 1:1 AV conduction is seen in fig4 (Almost same with post atropine response). We didn’t add PVI because GPs are triggers for AF in this young case. And No pace of course 🤣🤣
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I have been promoted as an associate editor in EB of
@JICE_EP
I would like to thank to
@hhuang123
EIC of
@JICE_EP
and all team. Please follow official account of
#JICE
to keep updated. Webinars, short movies, Twitter discussions and many more.
@JRWinterfield
@TinaBaykaner
8
3
62
CNA for VVS – A systematic Review and Meta-analysis Our paper was finally released in
@hrs_journal
@CarlChiefCard
@satish_r_raj
@derek_c1
6
20
60
Let me introduce my small but strong EP team
@YeditepeUni
from left to right Pic 1
@drmutluer
(EP Fellow)
@Alaraece
(Medical student)
@GizemEr61570918
(
@BiosenseWebster
Mapper)
@esrayesilyurtt
(EP nurse) Pic 2
@beratunlu34
(
@AbbottCardio
mapper), Serhat (Anesthesia technician)
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2
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From the second day of
#ESCCongress
@escardio
@ESCardioNews
With the legends of syncope
@ArturFedorowski
#MBrignole
@CarlChiefCard
#AMoya
@NRivasGandara
3
10
61
Dear colleagues Finally, we have a case-control study CNA (n=51) vs conservative therapy (CT) (n=50) in VVS. The 4-year KM syncope free rate was 0.86 for CNA and 0.50 for CT in the matched cohort
@JICE_EP
7
13
60
The first CNA in a patient with functional AVB (usually Mobitz type I and some high degree) and AVNRT. By the way,sinus node was totally normal. We have discussed and performed limited AVN vagal denervation with
@JRWinterfield
@hhuang123
@psharmadoc
@TinaBaykaner
and
@drrakeshg1
2
8
60
Classical distribution of ablation points for CNA in a patient with VVS. All points were targeted based on fragmentation.
@SobracO
@LAHRSonline1
@crpisani
@CarinaHardy4
@drluissaenz
@jczerpa
@ALFIEEP1
@josoriomd
@Davilandre
@EduardoSaad3
@LuigiDiBiaseMD
@aalahmadmd
4
14
61
QTc Shortening Effect: GP vs GP+PVI Our new work was just published in
@JCardioEP
i
@drrakeshg1
@YalinKivanc
@DrSerdarBOZYEL
@ihtanboga
@DrBradleyKnight
@DrMarwanRefaat
10
9
59
Hey
#EPeeps
please look at that. Now, I am together with my 2 virtual mentors but in person at this time
@CarlChiefCard
and
@Davilandre
It was to great to meet with
@EduardoSaad3
in person as well. Thanks
#HRS2022
make it happen
3
6
60
Procedural and Short‐term Results of Electroanatomic‐Mapping‐Guided GP Ablation by First‐Time Operators: A Multicenter Study
3
14
59
Our case investigating usage of ILR to evaluate absolute effectiveness of CNA was accepted for publication by
@JCardioEP
It is a hypothesis generating work for design of further randomized studies. Thanks to the Editorial Board and reviewers.
@KennethEllenbo1
@DrRoderickTung
8
9
57
What a great proud that our article is promoted as a top downloaded article in
@JCardioEP
Thanks to all contributors
@tomdepotter
@Davilandre
@DanielAlyeshmer
@srissundaram
@josoriomd
@JRWinterfield
@DhirajGuptaBHRS
@drdavidsingh
@javadm20
@50wattdoc
3
15
59
From
@CirculationEP
paper. 31 pts were enrolled in the current study. In 54.8% of cases, AVB was persistent in that there was Mobitz type 1, 2:1, or advanced AVB present at least 3 successive resting ECGs, and also at the start of the procedure.
4
16
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Classical lesion set of CNA for VVS from today’s case. For
#CARTO
fans 🤣. Yellow dots demonstrate His area. PMLGP wasn’t ablated.
@drrakeshg1
@jczerpa
@CarinaHardy4
@crpisani
@BorAntolic
@PiotrowskiRoman
@ftrae
@OscarVazquezEP
@DrFVassallo
@tomdepotter
@DrMYKim
@josoriomd
5
11
55
Catheter Ablation of Atrioventricular Block: From Diagnosis to Selecti... The first paper in
@JACCJournals
family.Importance of atropine, exercise test, and EPS in differential diagnosis of functional (vagal)AVB.
@drerkanbaysal
@drrakeshg1
@DrSerdarBOZYEL
5
20
57
Beauty of atria and GPs. This was the third GP ablation case in the new center
@yeditepeunihst
why do we see fragmentation in some irrelevant areas? Please wait our Anatomy Corner paper in
#JACCCaseReports
NEW CONCEPT Epicardial ganglia and neuronal extensions (subplexus)
2
9
55
Steps for selection of a mixed type VVS case for CNA. In existence of low BP component try Fludro or Midodrine first (Fig 1 is from ESC). After failed medication define contribution of CI component (Fig 2). Fig3 reveal HUT under fludro treatment. Based on fig 4, CNA is suggested
1
15
57
Well written Editorial about approach to PVCs by
@DrBradleyKnight
which was published in
@EPLabDigest
I would wonder your comments.
@DrRoderickTung
@Dr_Santangeli
@drrakeshg1
@DrJasonAndrade
@Hapa_EP
@Firaszahwe
@KrishKancharla
@DoctorPhillEP
@ALFIEEP1
@gautamsand
@CarinaHardy4
7
16
56
What a great pleasure. It is the 150th publication in my career and 30th in my new center
@YeditepeUni
CNA is associated with a better QOL in patients with VVS. Thanks to all co-authors.
🚨Newest
#FreeRead
Article in
@JICE_EP
Improved Health-related Quality of Life after Cardioneuroablation in Patients with Vasovagal Syncope
by
@drerkanbaysal
@drmutluer
@alaraecedagsali
@hhuang123
@MDTolgaAksu
📖🧐
#FreeRead
:
#EPeeps
#CardioTwitter
0
4
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8
6
55
It was a proudly day for me to learn more about ARVD ablation by 2 Turkish
#EPHero
@DursunAras2
and
@drtopaloglu
. They visited our clinic. 35 YOF. She admitted to clinic w electrical storm due to ARVD. We performed endo ILAM map first (1-2) and then epi ILAM map (3-4)
4
11
54
ECG of Clinical VT (Fig 1), activation (Fig 2) and reentrant maps with EGMs (Fig3, 4).
5
7
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I am so glad to see that I have been invited to
#ESC2022
to discuss CNA in an syncope session with the legends and authors of the syncope guideline. What do you think? Does CNA deserve a class IIb indication in young (<40YO) severe CI type VVS cases?
@escardio
@EHRAPresident
7
1
55
Hey Please look at that picture
@ftrae
@LuigiDiBiaseMD
@Dr_Santangeli
@HHsiaMD
Thanks
#HRS2022
and
@HRSonline
to make it happen
0
4
55
I feel deeply honored to be invited to
@AHAMeetings
#AHA2021
. We will get a chance to explain CNA idea in VVS in one of biggest scientific platforms. I would like to thank to all scientific committee members.
@drrakeshg1
6
3
54
Our EP case was accepted for publication in
@JICE_EP
I would like to thank the Editor-in-Chief
@andreanatalemd
, Editorial Board of journal and all reviewers for fast evaluation process and their scientific contributions.
@aalahmadmd
@LuigiDiBiaseMD
@DJ_Lakkireddy
@DrFerminGarcia
15
3
52
My first ILAM mapping attempt during sinus. Recurrent ICD shocks due to fast VT. VT was not tolerable. So, we decided to map during sinus. Brown dots were used to indicate localization of isthmus which were seen in Figure 2.
7
9
52
I feel honored to be invited to Editorial Board of
#ArrhythmiaAcademy
@radcliffeCARDIO
I would like to thank to dear friend
@DhirajGuptaBHRS
and Prof A Auricchio for their kind invitation. I am so excited to prepare some special sessions about ANS and Arrhythmias w dear Dhiraj
6
1
54
After
#EHRA2023
I have tried physiological pacing in a patient w post-ablation AVB. BTW, this is my first case without help.
@kvernooy
@psharmadoc
@GDandamudiMD
@Hisdoc1
@HaranBurri
Is it OK
7
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